Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis

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dc.contributor.authorBarretti, Pasqual [UNESP]
dc.contributor.authorPereira Doles, Joao Vitor [UNESP]
dc.contributor.authorPinotti, Douglas Goncalves [UNESP]
dc.contributor.authorEl Dib, Regina [UNESP]
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2015-03-18T15:55:48Z
dc.date.available2015-03-18T15:55:48Z
dc.date.issued2014-08-18
dc.description.abstractBackground: The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated.Results: A total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82-0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57-0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69-0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences.Conclusion: We showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol.en
dc.description.affiliationUNESP Univ Estadual Paulista, Botucatu Med Sch, Sao Paulo, Brazil
dc.description.affiliationUnespUNESP Univ Estadual Paulista, Botucatu Med Sch, Sao Paulo, Brazil
dc.description.sponsorshipConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
dc.format.extent11
dc.identifierhttp://dx.doi.org/10.1186/1471-2334-14-445
dc.identifier.citationBmc Infectious Diseases. London: Biomed Central Ltd, v. 14, 11 p., 2014.
dc.identifier.doi10.1186/1471-2334-14-445
dc.identifier.fileWOS000341784900001.pdf
dc.identifier.issn1471-2334
dc.identifier.lattes5496411983893479
dc.identifier.orcid0000-0003-4979-4836
dc.identifier.urihttp://hdl.handle.net/11449/117311
dc.identifier.wosWOS:000341784900001
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofBmc Infectious Diseases
dc.relation.ispartofjcr2.620
dc.relation.ispartofsjr1,576
dc.rights.accessRightsAcesso aberto
dc.sourceWeb of Science
dc.subjectPeritonitisen
dc.subjectPeritoneal dialysisen
dc.subjectTreatmenten
dc.subjectMeta-analysisen
dc.titleEfficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysisen
dc.typeArtigo
dcterms.rightsHolderBiomed Central Ltd
unesp.author.lattes5496411983893479[1]
unesp.author.orcid0000-0003-4979-4836[1]
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt

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